Shobha Shukla and Bobby Ramakant, CNS
Till recently, medical schooling curriculum did not include training for searching medical literature, doing systematic reviews or finding credible evidence from time-tested repositories such as The Cochrane Library. But in the last decade or so, medical training has incorporated some of the evidence-based medicine principles in countries such as Canada. Dr Jeremy Grimshaw, Director of Canadian Cochrane Centre and current co-chair of The Cochrane Collaboration globally spoke with Citizen News Service (CNS) on the sidelines of 22nd Cochrane Colloquium in Hyderabad, India.
Dr Grimshaw told CNS that the work of Canadian Cochrane Centre is focussed on capacity building and knowledge translation - to accelerate evidence-based medicine, policy and practice. "In Canada, we have a French language branch in Quebec and the main Canadian Cochrane Centre works in English. In the last 10 years, we have been organizing 8-10 training events every year, and have increased the number of authors from 700 to over 2000. We have demonstrated that as we offer training in evidence-based medicine approaches, we can also build up our author base. We are trying to see how can we increase the likelihood that the decision-makers whether they are citizens, professionals or the policy makers in Canada have access to that knowledge" said Dr Grimshaw.

Breaking silos and reaching out to partners to maximise synergy is the key. "We have created relationships with 25 partner organizations. So the major professional organizations, consumer organizations [consumers imply people who use or should potentially use Cochrane reviews], policy organizations, among others are on board. We tried to explore how can we work with them to get the cochrane knowledge in the hands of their members. We have held a series of events such as 93 knowledge translation events, reaching out to 2300 people. Some of these events were about: what does evidence-based healthcare mean to consumers, or how do we evolve evidence based policy for policy makers, or similar thematic areas."

Although Canada has been on the forefront of evidence-based medicine, there are some areas where other countries have made more progress. Dr Grimshaw said: "The term evidence based medicine was coined by Dr Gordon Guyatt, a Canadian. So we do have much more awareness of evidence-based medicine and concept of evidence-based decision making. But in some sense we are behind others, for example, we do not have a national license for free and open access to the Cochrane Library. India has provided free and open access to the Cochrane Library. We will like that every citizen in Canada has free access to evidence in Cochrane Library wherever they are. One of the roadblocks to free and open access to Cochrane Library in Canada is the nature of our healthcare system. We have federal ministry which largely focusses on public health and aboriginal communities and eventually we ended up having 10 different healthcare systems and quite a fragmented system. It is very hard to make a case for Canadian citizens to have free access to Cochrane Library without haivng to go through 10 different ministries to agree to do that. Despite long tradition of evidence-based medicine in Canada, we are not helping or enabling our citizens, professionals or policy makers to access knowledge the way India does."

Healthcare professionals in Canada who got trained 10 years ago did not receive any training in evidence based medicine. Citizens and policy makers are also less likely to have any scientific training. It is only since last 10 years that Canadian medical education has
become a lot better with healthcare professionals receiving some
training in evidence-based medicine. So capacity building on evidence-based medicine approaches is very instrumental. "Since last 10 years in Canada we have young professionals - physicians, nurses, physiotherapists among others - graduating and remaining evidence hungry, which is a very positive development. What
we need to do is to find a way to continue to feed their 'hunger' and
support them with evidence they need" said Dr Grimshaw.

Communications remain an obstacle too. "We need to find ways to communicaitng key research findings. We need to find a way to best communicate evidence which does not depend on the level of health literacy of the consumers such as healthcare professionals or policy makers. We have made progress on this front and our plain language summaries are a great resource but some way to go still" said Dr Grimshaw.

In Canada, 18% of systems run on French language. "Even if the healthcare professionals are trained in English, citizens and policy makers need the evidence in local language. French language Cochrane Centre has helped translate abstracts and plain language summaries in French which has seen a rapid uptake. Recognizing and respecting linguistic diversity is very important for our setting," said Dr Grimshaw.

"There is no one solution that will get our information to everybody. We need to have multiple approaches. One such approach is to work with partner organisations. For example we work with Canadian Arthritis Society who have used our abstracts and plain language summaries in English and French. If someone is dealing with arthritis in Canada she or he is more likely to access Canadian Arthritis Society than Cochrane for information. So we need to find ways to working with partners to whom people from different groups come for accessing knowledge."